Background

Few events cause more stress for the full time emergency physician than a pregnant woman at full term who is ready to deliver in the ED. This article discusses the delivery of a newborn in the ED; for a more general discussion of full-term obstetric delivery, see the Medscape article Normal Delivery of the Infant.

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Pathophysiology

Pregnancy and delivery are natural processes that have been occurring for millennia. For millennia, delivery of the pregnant woman was the province of nonmedical (such as there was) personnel. As medical care progressed, nurses began the systematic medicalization of prenatal, delivery, and postnatal care (nurse-midwifery). This transition began in Europe, eventually crossing the Atlantic.

In the United States, one of the earliest, most reputable, and still active groups is Frontier Nursing Service. Physicians have become involved only in the relatively recent past. Therefore, attendance to the natural course is mandatory; interventions are indicated only in the event of deviations from the natural or expected course.

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Epidemiology

Frequency

The precise incidence of US ED deliveries of pregnant full-term patients is unknown. In 2015, 3,978,497 births were registered in the United States. The fertility rate (births per 1000 women aged 15-44 y) was 62.5 births per 1000 women. Additionally, 8.07% had low birthweight, 9.63% were preterm, and 40.3% of mothers were unmarried. The cesarean delivery rate declined in 2015, to 32% of all US births.
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Age

Fertility rate statistics have 15 years as the lower cutoff point. However, laboratory testing should be performed to rule out pregnancy when any female capable of reproduction (potentially as young as 9 y) presents with abdominal complaints and when pregnancy cannot be ruled out at physical examination.